Mass Gatherings Medicine Dr Wayne Smith Division of

Mass Gatherings Medicine 1. Mass Gathering – An Introduction 2. South African Resource Model

Mass Gathering - Definition Large crowds are commonly associated with leisure events but may

South African Context • No established norms and standards • No Regulations • Often

1995 – Rugby World Cup 2003 – Cricket World Cup

FOOTBALL INCIDENTS Table. Football stadia incidents Casualties dead injured 318 500 Date Type Place

The average number of patients per game Patients per game around 10, 000 spectators

Mass Gatherings Medicine Risk Assessment a) b) c) d) e) f) g) h) i)

TEMPERATURE All Events PPR Apparent temp < 27 o. C Apparent temp > 27

AGE GROUP Age Range (years) Baseball Football Sporting Events Rock Concerts RC Location A

Patient Severity Distribution 90% 85% 80% Percenage of Patients 70% 60% 50% Old Trafford

Resource Model Validation Events Spectators Average spectators per event Patients Ellis Park 66 1,

A Hospital Response to a soccer stadium stampede in Zimbabwe • Sunday 9 July

Hospital Preparedness • Educate staff on heat-related illness if appropriate • Ensure that Hospital

CONCLUSION • Mass Gatherings shown to have higher rate of illness and injuries than

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Mass Gatherings Medicine Dr Wayne Smith Division of Emergency Medicine UCT/US PGWC - EMS

Mass Gatherings Medicine 1. Mass Gathering – An Introduction 2. South African Resource Model 3. Case Study

Mass Gathering - Definition Large crowds are commonly associated with leisure events but may occur at religious festivals, parades, and demonstrations and during public disorder. A figure of 1000 has been suggested to constitute a mass gathering

South African Context • No established norms and standards • No Regulations • Often decided upon by finances • Varies from one event to the next • Sport and Recreation Bill • Mass Gatherings Health Regulations

1995 – Rugby World Cup 2003 – Cricket World Cup

2010

FOOTBALL INCIDENTS Table. Football stadia incidents Casualties dead injured 318 500 Date Type Place 24 -May-64 Crush Peru 2 -Jan-71 Crush UK 20 -Oct-82 Crush Russia 11 -May-85 Fire UK 55 200 29 -May-85 Crush Belgium 41 437 Mar-88 Crush Nepal 100 300 15 -Apr-89 Crush UK 96 200 13 -Jan-91 Riot South Africa 40 50 16 -Oct-96 Crush Gatemala 84 150 11 -Apr-01 Collapse South Africa 43 155 9 -May-01 Crush 66 100 340 unknown Ghana 123 unknown (from Textbook of MIMMS, UK)

The average number of patients per game Patients per game around 10, 000 spectators Pts within the stadium Pts in the circumference of the stadium 24. 8 20. 7 14. 3 12. 1 9. 8 Oi ta be Ko ak a Os ka uo Sh iz ha m a a ko m Yo Sa ita ta Ni ig a i ak 11. 3 7. 0 6. 2 Ib ar ag i 6. 8 M iy o or Sa pp er ag e 8. 9 Av 12. 9

Mass Gatherings Medicine Risk Assessment a) b) c) d) e) f) g) h) i) j) k) Nature of the event Nature of the venue Seated or unseated Spectator profile Past history of similar events Expected number of spectators Event duration Seasonal considerations Proximity to hospitals Profile of hospitals Additional hazard

TEMPERATURE All Events PPR Apparent temp < 27 o. C Apparent temp > 27 o. C Baseball Football Concerts 6. 1 4. 85 6. 75 7. 49 4. 58 6. 11 4. 69 8. 1 5. 30 8. 90 8. 85

AGE GROUP Age Range (years) Baseball Football Sporting Events Rock Concerts RC Location A RC Location B 3659 1204 4863 1036 207 829 7, 655, 507 1, 709, 743 9, 365, 249 343, 318 268, 318 75, 000 <21 (%) 41. 2 17. 4 33. 2 70. 4 37. 7 79. 7 21 – 30 (%) 15. 7 24. 6 18. 7 22. 2 41. 4 15. 8 31 – 40 (%) 16. 2 31. 4 21. 3 6. 9 18. 8 3. 8 41 – 50 (%) 12. 1 15. 9 13. 4 0 1 0 >50 (%) 14. 6 10. 4 13. 2 0 1 0 Number Attendance

PRESENCE OF ALCOHOL

Queuing Procedures and Duration

Patient Severity Distribution 90% 85% 80% Percenage of Patients 70% 60% 50% Old Trafford 40% 30% Ellis Park 23% 20% 10% 6% 7% 0% Mild Moderate Patient Severity Severe

South African Medical Resource Model

Resource Model Validation Events Spectators Average spectators per event Patients Ellis Park 66 1, 224, 024 18, 545 266 Old Trafford 93 6, 061, 890 65, 182 1446 Total 159 7, 285914 1712 • > 92% Prediction Rate • where under predicted was for ILS at small events (< 5000)

A Hospital Response to a soccer stadium stampede in Zimbabwe • Sunday 9 July 2000 • South Africa vs Zimbabwe – National Sports Stadium Harare • 8 min from full time South Africa scored to take a 2 -1 lead • Glass bottle thrown onto the field hitting the goal scorer • Matched halted – Police respond with tear gas • In ensuing stampede 13 persons killed many injured FD Madzimbamuto Emerg. Med. J. 2003; 20; 556 -559

Hospital Preparedness • Educate staff on heat-related illness if appropriate • Ensure that Hospital Disaster Plan is a “living” document • ? Additional staffing for duration of the event • Most importantly establish reliable communications between EMS providers, other hospital etc • Be part of a holistic health response – break down the Silos and don’t shift the site of the disaster • Do what we do daily and do it well – then can easily escalate when required

CONCLUSION • Mass Gatherings shown to have higher rate of illness and injuries than general population • Wherever large number of people gather in one area there is an increased risk of a major incident. • Risk not just a function of number of persons attending • Mass gathering Medicine new and dynamic discipline • South Africa can become a leader